Nephrotoxin Stewardship

Kane‐Gill, Sandra L.

doi:10.1016/j.ccc.2020.11.002

Cited by 22 publications

(46 citation statements)

References 74 publications

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“…Sandra Kane-Gill hat in diesem Jahr erstmals, angelehnt an die bereits etablierten ABS-Programme, einen strukturierten Maßnahmenkatalog zum rationalen Umgang mit nephrotoxischen Medikamenten zusammengestellt 5 . Dabei verfolgt ein Nephrotoxin-Stewardship-Programm 3 Ziele:…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Spiegelkontrollen sollten engmaschig erfolgen. Zudem sollte bei jeder neuen Verordnung der Wirkstoff hinsichtlich seiner Nephrotoxizität und möglicher Interaktionen mit anderen bereits verordneten Wirkstoffen beurteilt werden 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Derzeit ist diese Hinweismeldung allerdings aufgrund fehlender IT-Schnittstellen oft nicht mit der GFR des Patienten verknüpft und/oder noch sehr fehleranfällig 6 . Ebenso wären automatisch erscheinende Empfehlungen zum Absetzen eines Medikaments oder Vorschläge für alternative Wirkstoffe sinnvoll 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

“…Darüber hinaus ist die Medikation auch nach einem ANV kritisch zu überprüfen, um weitere Episoden eines medikamenteninduzierten ANV und die Entstehung oder den Progress einer bereits bestehenden CKD zu verhindern. Dazu gehören insbesondere der rationale Einsatz von Statinen und ACE-/AT1-Inhibitoren sowie die Vermeidung von OTC-Medikamenten wie NSAID 5 .…”

Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

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Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Boss¹,

Kribben²

2022

Dtsch Med Wochenschr

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Section: Nephrotoxizität Und Nephrotoxin-stewardship-programmeunclassified

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Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Boss¹,

Kribben²

2022

Dtsch Med Wochenschr

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“…Healthcare professionals depend on primary, secondary, and tertiary information sources to enumerate potentially nephrotoxic drugs for practice and research. This is a tedious process and can be complex with the substantial discrepancy in nephrotoxins provided by various sources [ 9 , 10 ]. Further, rating the identified nephrotoxins based on their potential or likelihood of causing AKI is elusive given the lack of evidentiary support for such a comparison.…”

Section: Introductionmentioning

confidence: 99%

Consensus Obtained for the Nephrotoxic Potential of 167 Drugs in Adult Critically Ill Patients Using a Modified Delphi Method

et al. 2022

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Introduction The approach to evaluating nephrotoxins in studies of drug-associated acute kidney injury varies. Some studies use a list of under ten drugs for evaluation whereas others include over 100 drugs. Drugs are typically assigned a binary classification, nephrotoxic or not nephrotoxic. This oversimplifies the nephrotoxic potential of the drugs under investigation. Objective This study aimed to assign a nephrotoxin potential for 167 drugs used in the adult critical care setting. Methods A three-round, international, interdisciplinary, web-based modified-Delphi study was used to evaluate nephrotoxins used in adult critically ill patients. Twenty-four international experienced clinicians were identified through the Acute Disease Quality Initiative group and professional affiliations. Included individuals represented the fields of intensive care, nephrology, and pharmacy. One hundred and fifty-nine medications were identified from the literature, with eight additional medications added after the first round, for a total of 167 medications. The primary outcome was consensus achieved for nephrotoxicity ratings. Scores were evaluated each round to determine if a consensus was met. Results Our nephrotoxin potential index rating indicated that 20 drugs were nephrotoxicity probable or probable/definite per consensus. Nephrotoxic potential was assessed based on the standard use of medications in intensive care and the following consensus scores: 0 = no nephrotoxic potential, 1 = possible nephrotoxic potential, 2 = probable nephrotoxic potential, 3 = definite nephrotoxic potential. Conclusions The nephrotoxin potential index rating allows for prioritization of targeted drugs with greater nephrotoxic potential for institutional nephrotoxin stewardship programs. Furthermore, the nephrotoxin potential index rating provides homogeneity for research and guidance on detailed assessments by severity for each drug. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01173-4.

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A Systematic Review of the Costs of Drug‐Associated Acute Kidney Injury and Potential Cost Savings with Nephrotoxin Stewardship Prevention Strategies

Stottlemyer,

Tran,

Suh

et al. 2024

Clin Pharma and Therapeutics

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There is a scarcity of information related to the financial impact of acute kidney injury (AKI), and even more so the economics of drug‐associated AKI (D‐AKI). Our goal was to provide a comprehensive summary of the economic burden of D‐AKI by evaluating the costs of D‐AKI compared to not developing AKI and cost savings associated with nephrotoxin stewardship approaches. Following the PRISMA guidelines, a literature search was conducted using PubMed to identify articles from database inception through November 2023. The main outcomes included AKI incidence, resource use, and cost of nephrotoxin stewardship programs/D‐AKI event or no event. Key findings were summarized based on whether the study compared the cost of D‐AKI vs. no AKI or identified potential cost savings associated with a nephrotoxin stewardship method to prevent D‐AKI or worsening D‐AKI. All costs were adjusted to USD2023. Twenty‐five studies met the inclusion criteria. Eight studies compared the cost of D‐AKI to no AKI. Total admission costs of patients who developed D‐AKI ranged from $47,696 to $173,569. Nineteen studies implemented nephrotoxin stewardship with 12 substituting a less nephrotoxic drug; five using therapeutic drug monitoring and two altering drug dosing to limit exposure. Overall, these prevention strategies ranged from $5,171 to $364,973 in total medical cost savings and $17 to $942 in total cost savings per patient‐day. The in‐hospital economic impact of D‐AKI is substantial. Implementing nephrotoxin stewardship strategies to reduce D‐AKI is associated with cost savings. Institutions should adopt strategic and efficient nephrotoxin stewardship programs to optimize patient care and reduce costs.

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Nephrotoxin Stewardship

Cited by 22 publications

References 74 publications

Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Behandlung und Progressionsbeeinflussung des akuten Nierenversagens

Consensus Obtained for the Nephrotoxic Potential of 167 Drugs in Adult Critically Ill Patients Using a Modified Delphi Method

A Systematic Review of the Costs of Drug‐Associated Acute Kidney Injury and Potential Cost Savings with Nephrotoxin Stewardship Prevention Strategies

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